Manic Muses will be on hiatus for six to eight weeks (September – end of October) while I do some traveling. I will answer any comments when back online. Thanks in advance for the continued readership and support!
I’ve been meaning to write a follow-up to my February 12, 2013 post Mapping the Human Brain for months. The intention was to put on rose-colored glasses, include a few flashy graphics and get everyone excited about the advances this program could potentially make. But after reading information that came straight from the White House, it just didn’t work out that way.
Eight weeks after the BAM project was mentioned in the February, 2013 State of the Union Address, The White House published an infographic containing more information about the project. It’s a slick presentation, huge, long and somewhat boring, that potentially promises several soft deliverables and possible long-term outcomes. Get past the pretty graphics however, and there are three key points of interest.
The first thing of note is the name of the initiative has changed – from BAM to BRAIN, an acronym for Brain Research (Through) The Advancement of Innovative Neurotechnologies. Why the rebranding? I guess BAM may have been too closely associated with a cooking show or something, and the Fed spinmeisters wanted an acronym more snappy and relevant. The second item of interest is the budget. At $100 million US dollars, it seems to be on target to kick off an initiative of this magnitude.
Moniker and budget aside, further down the graphic is a list of three US government agencies who will contribute to BRAIN. It’s understandable the NIH (National Institutes of Health) and the NSF (National Science Foundation) are involved. However, the agency receiving the biggest chunk of funding – half to be exact – is DARPA , Defense Advanced Research Projects Agency. For those unfamiliar with this organization, it is a branch of the US Department of Defense.
DARPA dabbles in everything from passive radar to robotic armies. And DARPA has quietly been in the brain biz for decades. The agency has released some information here and there regarding its endeavors, but for the most part, and for most people, their neuroscience research and discoveries have flown under the radar. For those who have heard of DARPA, chances are it’s because they keep a low-key, positive image in the public domain by peppering mainstream periodicals such as Popular Science with a menu of underway and wish-list programs for the civilian population to peruse and marvel at.
On the surface, it all sounds as cool as DARPA wants it to. So is there any reason for concern about the agency dominating the BRAIN budget? Fair warning: this is about to get weird.
In an article published this past May in Scientific American, John Horgan explains, Why You Should Care about Pentagon Funding of Obama’s BRAIN Initiative,
There’s nothing new about the militarization of brain science. Ten years ago, when I was writing an article on how information is encoded in the brain, Darpa was already a major funder of research on neural coding and neural prosthetics. Darpa program manager Alan Rudolph told me back then that the agency was interested in a wide range of potential applications, including “performance enhancement” of soldiers via either implanted or external electrodes linked to electronic devices.
I’ll leave it to you, reader, to peruse the original article to which John Horgan is referring and draw your own conclusion about what DARPA has been up to in brain science over the last 15 years on the dime of the Federal Government.
If it all sounds like the stuff from which movies are made, it is. In reality, funding a Hollywood film about ‘futuristic-brain-type-stuff’ may be more difficult than getting the US government to pony up for the real thing. There is actually a how-to handbook that guides neuroscientists through navigating the process for obtaining research funding from the military.
“…as I have pointed out previously, neuroscientists are pursuing military funding much more eagerly and openly, as evidenced both by the BRAIN Initiative and by this 2009 publication of the National Research Council, Opportunities in Neuroscience for Future Army Applications. Overseen by leading neuroscientists, including Floyd Bloom and Michael Gazzaniga, the report advises researchers how to tap into military funding. The report advocates “…enhancement of soldier performance, and improving cognitive and behavioral performance using interdisciplinary approaches and technological investments.”
And what a pool of funding there is to be had. In 2011 alone, the US Department of Defense spent more than $350 million US dollars on neuroscience - that they are willing to admit to.
Since the military is now openly recruiting and funding brain research, it begs questions from many camps, including the scientific community, future neuroscientsts and even (quite colorfully, I might add) conspiracy theorists. Is the military fast becoming one of the only ways to acquire funding significant enough to perform meaningful neuro research? Could this result in brain research being monopolized for defense purposes? If this emerging model of funding becomes the norm, will it stifle the creation of a diverse network of contributors through which innovation and discoveries can be pooled in order to make significant advances?
Definitely food for thought.
“Come and hold my hand, I want to contact the living.”
Feel – Robbie Williams
Robbie may be singing about love, but I’m talking about being desperate to rejoin the land of the living after two weeks of dealing with migraines and residual headaches.
Migraine probably isn’t new to you if you have bipolar disorder. One study revealed that 82% of participants with bipolar II had migraine, compared to 27% of the patients with bipolar I. There are many more daunting statistics out there – all you have to do is Google “migraine bipolar disorder.” Personally, although I’ve had these kick-ass headaches since I was a kid, my migraines stem largely from an old injury being re-injured. But, whatever. The end result is still the same pain-ridden hell.
So, for those without migraine who can stand to stare at a computer screen and do a little bit of reading, here are some interesting links about migraines in general.
Ah, yes. What you can and cannot do in life. Here’s a recent article from Huff Post on 10 surprising migraine triggers. (Not so surprising, really. I can relate to four of them!)
Then, there is an article from Time Healthland by the kill-joy Nolan Feeney, who tries to argue that Migraine Triggers May Not be So Potent After All. (Oh, neurologists who participated in this study. You are ridiculously oversimplifying things. I bet none of you has ever had a migraine, either.)
This article from the Mayo Clinic is very thorough. Migraine sufferers – this is a pretty complete menu of available treatments out there. If your treatment isn’t working, consider taking this to your doc and see what else you might try. Bipolar patients – have a look at the antidepressant and anti-seizure med section. It’s possible you’re already on one of these meds.
And finally, there is (in my opinion) the gold standard for chronic migraine treatment. OnabotulinumtoxinA or Botox. Having these injections every three months changed my life, and when I lived in Seattle, I was lucky enough to have Dr Sheena Aurora as my physician. (Oh, Dr Aurora, how I miss you!)
I’ve been loathe to admit that while not sitting at a computer working 16 hours a day has improved my headache profile significantly, it hasn’t killed the migraine beast altogether. So, I’m off to track down a clinic here in The Netherlands that offers the OnabotulinumtoxinA treatment. (My idiot GP refused to do it. He literally told me, “…you have more time than I do to look [for a facility],” which doesn’t bode well.) Insurance be damned! If I have to travel to London for treatment, so be it.
If anyone out there knows of a clinic in The Netherlands that offers the old Botox-for-Migraines service, please let me know.
And, Manic Muses will be back online as soon as I can get this under control.
[Going to find those Immitrex tablets now. The beast has awakened from this short stint in front of the computer.]
According to World Health Organization (WHO) statistics, mental illness is experienced equally by men and women. A Time Magazine article would like to challenge that idea.
…this is inaccurate. When you take a detailed look at the international epidemiological data, as we did when writing The Stressed Sex, the picture that emerges is very different – and pretty shocking. It turns out that in any given year total rates of psychological disorder are 20-40% higher in women than men.
The theory behind why the international epidemiological data points in this direction:
What we do know is that social stresses make people vulnerable to mental illness, and research indicates that women’s roles may be especially demanding.Considering that on the whole women are paid less, find it harder to advance in a career, have to juggle multiple roles, and are bombarded with images of apparent female “perfection”, it would be amazing if there wasn’t some emotional cost. Women are also, of course, much more likely to have experienced childhood sexual abuse, a trauma that all too often results in lasting psychological damage.
It is an interesting proposition, but I’m inclined not to dismiss WHO’s figures so quickly.
Read more here.
I’ve been out of the loop for a while, unplugged so I could help my niece with her master’s thesis. When I agreed to check grammar and spelling (English is not her first language, but man, is she good at it) I figured I was getting myself into reading hundreds of pages about the finer points of con trails or worm hearts or some esoteric stuff like that. Well, it wasn’t a yawn-fest at all. Her thesis deals with the pharmacy as an adjunct care center and the software that goes into tracking the proper indicators to recognize effectiveness and efficiency in patient care.
Right up my alley!
I hadn’t thought much about my pharmacy experience here in good ol’ NL, but comparatively speaking, I see a huge, positive difference in the pharmacy ‘care’ I receive here in contrast to my experiences in the US. In America, I was given my pills and a hefty leaflet, asked if I had any questions for the pharmacist and sent on my way. Well, I always wondered, if it’s a new med how the heck am I supposed to ask intelligent questions when I haven’t even swallowed a pill yet? Oh, yeah. And about that leaflet? I would read them (sometimes) but of course, especially with psychiatric med, the general information was kinda useless in most cases. My pharmacy experiences in the US seemed largely reactionary, the pharmacist inserting themselves only when some question or problem is brought to them.
Except when a three-month supply of med arrived in the mail. Then, I was pretty much on my own.
In The Netherlands, the model (although still evolving) is quite different. To say the pharmacists here are proactive instead of reactive is an understatement. Pharmacists are given more latitude to actively participate in a patient’s care. One example is the expectation by the medical establishment that pharmacists will be knowledgeable enough to recommend an adjunct, over the counter med in conjunction with the medication the patient is receiving, if that additional OTC med will reduce the amount of side effects the patient may experience. The example my niece used was the suggestion of a laxative to those patients prescribed a narcotic (constipation is a pretty common side effect). Pretty much common sense, right? Doctors often don’t discuss this particular gem of a side effect and it’s the pharmacist who, in cases like this, winds up filling the void left in between most patient’s being prescribed the med, popping that first pill of the treatment and then having pretty common issues somewhere down the line.
The set of indicators used to evaluate the quality of adjunct care is still evolving but there is a good start. Of course, targeted software is beginning to make its way on to every computer in Dutch pharmacies. Which is a very good thing, since not only lists of drugs that a patient takes and drug interactions can be generated, but the patient record can now include more robust details, including the condition for which the medication was prescribed, whether the patient was offered an OTC to help with side effects, whether or not they declined the OTC and the reasons why, etc. With a bit of imagination, I’m sure everyone can come up with other ways this capability can be used. Also of importance to the pharmacy, these systems afford the ability to rate a pharmacist’s performance and gives the pharmacy itself a rating that is used when funding allocation is at stake.
This all sounds well and good. Does it really work? Well, yeah. When I went to fill a prescription for a particularly nasty Class Three med when my insomnia was out of control, I joined my pharmacist at the consultation station – which is expected and not an option – for a full fifteen minutes. It was beyond enlightening. The way this medication works is a bit, well, ‘interesting’ and it could cause side effects my doc never even remotely discussed. Not just the garden variety stuff, either. Try and fit that on a pamphlet I’m not going to read anyway. We talked about my condition, interactions, what I should do in the event a nasty side effect did arise, how it could affect other health problems I have and whether there were any alternatives out there (yeah, this med scared me that much). After I left the pharmacy, I got a call from my pharmacist. She wanted to be absolutely certain I heard and understood I could not, under any circumstances, drive the car. At all. During the course of treatment. If I were in an accident it would be an extremely bad deal. (The Dutch justice system is a lot more unforgiving than the American one about people having Class Three substances in their system.) That tidbit would certainly not have been included on any pamphlet from Rite Aid. And certainly wouldn’t reach my ears if a three-month supply of med arrived in the mail.
As I read this back there is something missing from my description of this Dutch model of care. The difference really lies in attitude. Pharmacists (it seems to me, anyway) are more respected and interact with physicians a lot more than in the US. The superiority complex that most docs bring into interactions with nurses and pharmacists doesn’t seem to exist as much here. Which gives the pharmacist confidence to act as a partner instead as an underling pill counter. This isn’t something my niece touched upon in her thesis, but it screams to me loud and clear every time I need to get or refill my stupid med. I have a lot more confidence in the medication choices my docs make and the pills I choose to swallow because of my pharmacist. I’m better informed. About the medications, how they work, what their interactions are and what else I could be doing to make the cocktail boat sail a bit smoother.
Bottom line: here in NL as far as meds go, I’m being double-teamed. And, I kinda like it. Thanks to my niece, I now realize it and fully appreciate it.
Landmark decisions today, people! Gay and lesbian couples who are legally married in a state that recognizes gay marriage cannot be denied federal rights or protections. And, although the ruling is somewhat confusing, it looks like gay marriage can resume in California.
You know what? As a person who belongs to a ‘fringe group’ (the mentally ill) that is often disenfranchised and stigmatized, it warms my heart so much to see gays and lesbians, who often suffered the same prejudice as those with mental illness, finally embraced and legitimized.
Can I say it again?
I’ve meant to do a follow-up to my Is There Now Evidence Withdrawal From Antipsychotics Can Induce Psychosis? post for a while. This is one of the most popular posts on Manic Muses, and this important subject deserves a regular revisit. So, thanks to Someone Else for leaving a comment on the original post and prodding me into finally getting this one done.
What I’m hoping to do this time around is foster more discussion. And for those who believe their medication may have made them worse – You are NOT alone.
Below are two important resources readers were kind enough to share with me. Have a look at the excerpts provided, click into the articles and be amazed.
Somebody Else supplied this link. This article, Antipyschotics Worsen Long-term Schizophrenia Outcomes obviously deals with treatment of schizophrenia and not bipolar disorder, but addresses the possible effects of antipsychotics none the less.
Harrow and Jobe are stating that the high relapse rate that occurs in the drug-withdrawal studies may be an artifact of the patients having been on the drugs in the first place. The drugs induce a dopamine supersensitivity, which puts the patients at high risk of a “medicine-generated psychosis” upon drug withdrawal. And if this is so, then the entire evidence base for long-term use is based on a delusion: mistaking the high relapse rate for a sign that the “disease” is returning, when in truth it is related to prior drug exposure.
Well, I don’t know about you guys, but I can certainly relate. Is my disease getting worse? Do I really need to stay on the antipsychotic? The answer was no, but these thoughts did go through my antipsychotic-addled mind. The same dynamic was at play with the son of a gentleman I used to correspond with. It was a vicious cycle. The son was bipolar but not responding well to the anitpsychotic he was given. He was told to discontinue the med slowly and his psychosis became so serious, he had to be restrained by paramedics to be safely transported to a hospital. Where he had to resume taking the anitpsychotic to quell the psychosis. And round and round he went. For at least two cycles that I know of it, in fact. The short of it – his disease wasn’t getting worse, he was indeed made psychotic by the very med developed to prevent psychosis.
Rhona Finkel, who blogs at WordPress for http://candidaabrahamson.wordpress.com, supplied the next resource.
In the very elegantly titled, Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse (take a breath), the Summations section proves to be quite interesting:
Discontinuation of clozapine and possibly other antipsychotic drugs may provoke a rapid onset psychotic episode that may be distinct from the underlying illness in some patients.
Concerns that withdrawal of antipsychotic drugs may increase risk of relapse above the risk associated with the underlying disorder need further investigation.
Mechanisms are uncertain but interest has centred on brain adaptations to long-term drug use.
It’s the end of the sentence in the second point that’s critical. ”Concerns that withdrawal of antipsychotic drugs may increase risk of relapse above the risk associated with the underlying disorder need further investigation.” This isn’t the first time we’ve seen that highlighted phrase when it comes to antipsychotics. So, is there any further investigation taking place? I did a cursory bit of research and could find nothing.
The issue of antipsychotics causing psychosis is alive and well. And still needs to be discussed. Vigorously. And researched. Extensively.
If anyone has a story or a link to a study to share, please post in the comments. I’m sure there will be a third installment to the Can Antipsychotics Can Induce Psychosis? saga.
Here are some further resources. Thanks again to Somebody Else for providing them.